Earlier this month, I wrote an article from Zambia, considering the preeminence the Trump administration is granting faith-based groups in its global HIV response.

Washington has now cut off much of civil society, including organizations run by people actually living with HIV. Those groups have lost U.S. funding and were excluded from negotiations over new bilateral health financing deals Washington has sealed with partner countries.

Included in those talks? The leaders of faith-based organizations, or FBOs. This was after the State Department actually named FBOs in its new America First Global Health Strategy, along with the private sector, promising to leverage their services in the response.

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Traveling to Zambia, I was less interested in why FBOs had been singled out. Reporters in Washington can explore whether that is purely an ideological decision or one based on decades of evidence on the cost-effectiveness and quality of FBO interventions.

Instead, I wondered: If FBOs are set to remain one of the few conduits for U.S. resources – resources that will remain vital to efforts to continue battling the AIDS epidemic – to what degree will they be able to take over the work of the organizations that have lost support? To what degree can they sustain a suddenly fragile HIV response?

What I discovered was some confidence in their capacity, but a lot of apprehension, particularly within communities that have historically faced discrimination and recrimination from faith leaders.

After the story was published and I sent it around to the people I had interviewed, a Zambian activist wrote back to kindly explain that I had missed the point. That in cooperating with the Trump administration, those organizations have forfeited any trust vulnerable communities might have had in them, leaving them in no position to sustain the HIV response.

I thought it important to share this perspective, whether you dispute it or not. If it is widely held — and it seems to be, this perception has the potential to further restrict care for marginalized communities and deepen fissures within the networks of service providers.

Vulnerable communities in Zambia now understand U.S. HIV funding as having been subsumed into the Trump administration’s broader ideological agenda. That it has been weaponized by an administration steeped in Christian nationalism to diminish and harm communities that do not reflect those values.

There is a predictable and unfortunate overlap with the communities contending with the highest rates of new HIV infections: LGBTQI+ people, sex workers and people who inject drugs. That has allowed the Trump administration to leverage its global HIV financing to extend its punitive attitude toward members of those groups living beyond U.S. borders.

Indeed, from the moment he first suspended aid funding, there was a conviction within these communities that this was part of an effort by Trump to try to actually eliminate them.

“We are not sure whether this is a mission intended to sweep us away,” as Macklean Kyomya, who runs a health program for sex workers in Uganda, put it just weeks after the suspension.

Their suspicions seemed to be confirmed by the broad cuts the administration then enacted on U.S. programs for marginalized communities, even as it reinstated other services. The State Department claimed to make these decisions based on whether programs met its definition of “life-saving.” That slippery criteria was baffling to these communities, some of whom risk being denied services or even being arrested at state-run facilities. In that context, how were the specialized clinics they were losing not also life-saving?

And the expansion of the global gag rule in January further validated those fears, now prohibiting organizations that receive U.S. aid from providing gender-affirming care to transgender people, even if they use separate resources. While the restrictions are specific, the effect may be that wary organizations enact a general prohibition on providing services to transgender people.

For my source in Zambia, this has all crystalized what they had long suspected: “They have some agenda they are pushing” through U.S. global health financing. And in their reading, anyone who accepts funding under the highly restrictive terms of the America First Global Health Strategy is complicit in that agenda, which seeks not only to exclude vulnerable communities, but to actually eliminate them.

It does not matter that FBOs have a long history of caring for the indigent, the marginalized and the vulnerable when no one else would. It does not matter that faith-based groups have at least some capacity to take over the services that these community-led organizations can no longer provide. It does not matter that the leaders of the FBOs, even as they prepare to accept U.S. funding, also promise no one will face discrimination at their facilities. (Though it does not help that they encourage people to not be too transparent about their identities.)

If they agree to receive money from the Trump administration, there is a perception that these FBOs have passed some kind of ideological litmus test.

“It’s a good one on paper for the church, but the bias and discriminatory practices still exist,” my source wrote me.

So the point is not whether faith-based groups, buoyed by U.S. funds, can step in where community organizations have been forced to retreat. It’s that the people who relied on these services have fully lost any trust in providers they understand to be, at the very least, willing to tolerate a Trump administration determined to persecute them.

Agree with this perspective or not, the outcome is still that these communities will be driven further underground and HIV spread continue.

So if FBOs are ultimately sustained by U.S. funding, they need to truly understand the dynamic this creates. And if they actually mean what they say about supporting everyone, more than ever the onus is on them to prove it.

On a personal note, I was honored to see my reporting featured on John Oliver’s latest episode of Last Week Tonight. It was part of an incredibly significant segment exploring the reasons behind the dismantling of U.S. aid and recalling the people who have suffered as a result. I would encourage you to watch it.